Polycystic Ovary Syndrome

Our providers have evaluated and treated many women for Polycystic Ovary Syndrome (PCOS) associated with infertility. Our clinic offers evidence-based treatment for PCOS in Hawaii on the Islands of Oahu, Maui, and the Big Island.

Definition:

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder, which affects up to 6 – 10% of premenopausal women. Features include a lack of regular ovulation and excessive production of androgens (male hormones such as testosterone). Symptoms vary but can include multiple, small cysts (follicles) of the ovaries, irregular or absent periods, excessive body hair growth, difficulty with weight gain and infertility.

Features of PCOS:

Often appears at the in the teens or 20’s or after a period of significant weight gain.

Often associated with insulin resistance; a combination of high blood insulin levels and insulin-hypersensitive ovaries results in the overproduction of (male hormone) testosterone, thus preventing ovulation. Insulin resistant women often have an “apple shape” where fat is deposited around the middle and patches of darkened thickened skin called “acanthosis nigricans” in the groin, armpit and skinfolds.

When women with PCOS become pregnant, they are at increased risk for first trimester miscarriage and for the development of gestational (pregnancy induced) diabetes.

Elevated levels of male hormones in women with PCOS cause excessive hair growth on the face, chest, and abdomen, the development of acne, hair loss, and weight gain.

Obesity can worsen PCOS because it enhances the abnormal estrogen and androgen production associated with PCOS.

PCOS can increase a woman’s risk for the development of adult onset diabetes, elevated cholesterol and triglycerides, cardiovascular problems, endometrial cancer. Untreated, the lifetime risk of heart attack in PCOS may be as high as 7X normal.

A family history of diabetes, weight problems, infertility or abnormal hair growth.

Treatment

Ovulation induction: The most common drug used to induce ovulation in women with PCOS is clomiphene citrate (Clomid®). Four out of five women with PCOS do ovulate using clomiphene, but only one in three will actually become pregnant. Injectable fertility drugs are about 90% successful over 6 cycles in producing pregnancy in the absence of any other fertility problems. These treatments can be combined with intrauterine insemination or timed intercourse. If these treatments both fail, IVF is usually considered.